Swimming after a stroke

18/03/2024

This fact sheet explains how you can participate in swimming and other aquatic activities if you have had a stroke.

There is also an aphasia friendly version of this fact sheet, available for download here.

Introduction

Stroke is a condition caused by the disruption of normal blood flow to the brain. The effects of a stroke vary depending on which part of the brain has been affected and the extent of damage. Stroke remains one of the leading causes of disability worldwide. People who have had a stroke may experience lasting issues with mobility and independence as well as pain, fatigue, and cognitive and emotional problems.

Getting active again after a stroke can help improve general health and mood, improve strength and flexibility, reduce fatigue and pain, and lessen the risk of another stroke. Swimming or aquatic activity can be of particular benefit as exercising in water offers a range of benefits not seen with land-based exercise. For example, the water pressure and buoyancy make movement easier and reduce the risk of falling during exercise. The resistance provided by water can also be used to improve muscle strength.

Research studies and evidence reviews suggest that exercising in water after a stroke can lead to significant improvements in:

Balance (reducing the risk of falls).
Fitness levels (reducing the risk of further stroke).
Independence (reducing reliance on others).

What you need to know when considering swimming after a stroke

Before

Check access arrangements in your local pool, particularly if you need assistance getting in or out of the water.
Getting back in the water might feel intimidating – swimming or exercising with a friend or family member can help.
Find out about changing facilities – consider if you might need help undressing and dressing.
Remember that the area around the pool may be wet – take care, especially if you use a walking aid.
Some people feel self-conscious about their body after a stroke – swimwear that offers more coverage may help you feel more confident.
If you are experiencing continence issues as a result of your stroke, specialised swimwear is available.
If you are experiencing cognitive issues, e.g. remembering things, it may help to plan ahead. For example consider marking your locker so you can find it easily.
Make sure that you are well hydrated before you swim. You can also have a light snack an hour before you exercise.

During

If you have any weakness because of the stroke the water can help you move more easily and feel supported.
If your joints feel stiff, water can offer a gentle stretch to increase flexibility.
Buoyancy aids such as noodles, floats and swim vests can provide extra support and give you confidence. Check what your local pool has available.
Warm up before every session – try activities like marching on the spot in waist high water or gentle leg kicks whilst holding onto the side of the pool.
Aim to do some moderate intensity exercise – this means including some swimming, aqua-walking/jogging, or other exercise that increases your heart rate but doesn’t make you so breathless that you can’t speak.
It is also helpful to practice balance and strengthening exercises in the pool. These may include balancing on one leg (with or without eyes closed), squats, lunges and repeated push and glides from the poolside.
Do what feels right for you – even short bursts of exercise can be very beneficial.
Build up your aquatic activity gradually, aiming to spend a little longer in the water each time.

After

Cool down with some gentle activity – this allows your heart rate to decrease gradually.
Always leave the pool feeling that you could do more – remember that getting showered, dried and dressed can be quite tiring.
Once you are dressed, make sure you have a drink to replace water lost during exercise.

Tips for swimming in recovery from stroke

Do:

consult your stroke specialist or GP before taking part in any activity.
consult with your physiotherapist if you need advice about adapting the way you swim or exercise in the water.
plan your exercise around your daily routine to reduce fatigue.
enjoy your time in the water but stop if you feel any unusual symptoms such as extreme breathlessness, tightness in your chest, dizziness, double vision or nausea.
start off small and build up your swimming or water based exercise at a pace that works for you.
make contact with your local pool to find out what extra activities they have available – you may wish to look for swimming sessions with other people who have experienced stroke or other long term conditions.
aim for 150 minutes of moderate intensity activity every week – swimming and aquatic exercise are great ways to help achieve this.

Specific tips for other disciplines

Open water swimming (over and above standard open water guidance):

Do:

think about the temperature of the water – cold water may be associated with greater risk, particularly if you are not used to it. Always consult with your stroke specialist or doctor first.
consider the accessibility of entry and exit points.

If you are swimming abroad:

Do:

ensure that you take a copy of your prescription and extra medication in case any get lost or stolen.
consider local pool hygiene standards as these may be variable.
wait at least two weeks after a stroke before flying.